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Volume 29, Issue 1
Displaying 1-25 of 25 articles from this issue
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Masutsugu Fujita, Hiroyuki Naitoh, Nobukuni Terata, Masashi Kodama, Ky ...1996 Volume 29 Issue 1 Pages 1-6
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSMAGE (melanoma antigen) gene family, including MAGE-1, -2, -3, -4 and-6 genes that encode the human tumor-rejection antigen recognized by autologous cytolytic T lymphocytes, preferentially is expressed on many tumor cell lines as well as fresh tumor cells of various organs such as breast carcinoma, lung carcinoma, and gastric carcinoma, but is not expressed on a panel of normal tissues except testis, placenta, and skin during wound healing. We tested 15 surgical specimens of esophageal carcinomas and observed MAGE gene expression at the mRNA level in 10 out of 15 cases (67%). The results suggest that MAGE antigens are an approriate target molecule for specific immunotherapy in substantial proportions of patients with esophageal cancer.View full abstractDownload PDF (11847K) -
lndication for the Omission of No.1, 3, 4sb, 5and No.7Lymph Node DissectionHidetoshi Suzuki, Setsuo Akaishi, Takashi Itoh, Toshiaki Baba, Mitsuhi ...1996 Volume 29 Issue 1 Pages 7-13
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIndications for omitting dissection of lymph nodes 1, 3, 4sb 5 and 7 in early gastric cancer of the A region were studied in 412 cases of resected cancer of the A region (early 188, advanced 224) and 443 cases of early gastric cancer (m 231, sm 212). All in 25 cases of cancer in the A region with metastases to lymph nodes 1 and 4sb were at ss or beyond in depth and over 5 cm in diameter. Metastases were absent in lymph nodes 3, 5 and 7 in m cancer and in patients with lesions under 3 cm on the greater curvature. Review of all m cancers showed that 5 cases with metastases were U1 (+) and depressed, and the only differentiated lesion with metastasis was a IIc + III·tub2 cancer. Among sm cancers, metastases were absent in elevated lesions under 1.8 cm and carcinomas under 1 cm. These findings suggest that dissection of lymph nodes 1 and 4sb may be omitted for elevated cancer under 5 cm, U1 (-) and U1 (+) ·tub1 IIc m cancer, elevated sm cancer under 1.8 cm and sm cancer under 1 cm. With lesion on the greater curvature, the indications include sm cancer under 3 cm too, and dissection of lymph nodes 3, 5 and 7 can be omitted for, Ul (-) and Ul (+) ·tub1 IIc m cancer under 3 cm, and sm cancer under 1 cm, all in the A region.View full abstractDownload PDF (13520K) -
The Siggnificance of Paliative ResectionYoshihiro Moriwaki, Ken Yamanaka, Kazutaka Koganei, Hiroyuki Kure, Tak ...1996 Volume 29 Issue 1 Pages 14-20
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA clinical study on intraperitoneal invasive recurrent gastric cancer (REC-G, 23 cases) and colorectal cancer (REC-C, 18 cases) was performed. In P0, P1, and P2 cases of REC-C, the ratio of discharge was 100% in curative cases (CUR) and palliative cases (PAL) and 40% in unresected cases (UNR) and the mean survinal was 731, 468 and 174 days. In P0 and P1, cases of REC-C, the ratio of discharge was 100% in CUR, 80% in PAL and 67% in UNR and the mean survival was 1087, 443 and 306 days. The ratio of discharge and prognosis was better in CUR and PAL in both groups. In P3 cases of REC-G, there was no CUR cases and the ratio of discharge was 67% in PAL and 29% in UNR and in P2 and P3 cases of REC-C, 75% in PAL and 33% in UNR. Concerning the mean survival, there was no difference between PAL and UNR though the ratio of discharge was better in PAL. In P0, P1, and P2 cases of REC-G and P0 and P1, cases of REC-C, there was no decrease in survival according to operative stress of the resection if the resection was palliative. We concluded that operative treatment should be tried for intraperitoneal invasive recurence if there is a possibility of decreasing the symptoms.View full abstractDownload PDF (14554K) -
Masaaki Otsuka, Akio Ishikawa, Kenji Yuzawa, Hiroyuki Iida, Tadashi Ko ...1996 Volume 29 Issue 1 Pages 21-25
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo study the effect of ischemic injury on drug metabolism after liver transplantation, the pharmacokinetics of tacrolimus and trimethadione (TMO) were examined after canine liver transplantation. Tacrolimus (0.3mg/kg) was administered intravenously over 30 minutes. Whole blood levels of tacrolimus were determined by ELISA. TMO (4mg/kg) was rapidly injected intravenously. Serum levels of TMO and its metabolite dimethadione (DMO) were determined by gas chromatography. Pharmacokinetic analysis was made on the 1st and 7th posttransplant days, and compared with the control group in which the animals did not undergo the operation. Animals of both groups received an oral dose of tacrolimus (0.3mg/kg) on the other post-operative days. On the 1st post-transplant day, the cl arance of TMO and serum ratio of DMO/TMO 2 hours after the administration were o.94±0.41 ml/min/kg and 0.22±0.13 in the liver transplant group (n=5). These were significantly lower than those of the control group (2143±0.78ml/min/kg and 0.91±0.30, n=5). On the 7th post-transplant day, the clearance of TMO and the serum ratio of DMO/TMO were 3.65±1.74 ml/min/kg and 1.35±0, 96 in the transplant group. No statistical difference was found between the two groups. The clearance and the whole blood levels 24 hours after the administration were compared to evaluate the pharmacokinetics of tacrolimus. No statistical differences were found between the transplant group and the control group on the 1st or 7th post-transplant day. The results indicate that the metabolism of TMO is more vulnerable to ischemic injury than that of tacrolimus. This suggests a difference in susceptibility to ischemia between P450 subspecies.View full abstractDownload PDF (8923K) -
Analysis of Bile Bilirubin Subfractionations by High Performance Liquid ChromatographyShuichi Ishiyama, Akira Fuse, Joji Tanaka, Masahiro Urayama, Yukio Iga ...1996 Volume 29 Issue 1 Pages 26-31
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn order to investigate the pathogenesis of hyperbilirubinemia after major hepatectomy, we studied 21 patients with biliary tract cancer. Those patients were divided into three gruops: a non-hepatectomy control group (n=8), and non-icteric (n=8) and icteric (n=5) hepatectomy groups. In the icteric group, the serum bilirubin level was above 2.0 mg/dl even two weeks after surgry. Bile bilirubin subfractionations were analyzed by HPLC. The proportions of bilirubin diglucuronide (BDG) decreased on the first postoperative day in all three groups, whereas those of bilirubin monoglucuronide monglucoside (BGG) and monoxyloside (BGX) increased. The grade of this abnormality was most severe in the icteric group among the three groups. In the icteric group, these changes were kept at significant levels compared with both the control and non-icteric groups. These changes could cause difficulty in bilirubin transport across the cell menbrane of hepatocytes so that hyperbilirubinemia might occur after major hepatectomy. The analysis of bile bilirubin subfractionations seemed useful for the evaluation of hyperbilirubinemia after major hepatectomy.View full abstractDownload PDF (10951K) -
Ryouchi Tomita, Shigemichi Koshinaga, Yoshizo Abe, Katsuhisa Tanjoh, Y ...1996 Volume 29 Issue 1 Pages 32-37
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe motor activity of the sphincter of Oddi(SO) was evaluated by endoscopic manometry in 34 subjects, 12 with and 22 without juxtapapillary duodenal diverticula(JPD). In subjects with JPD the SO basal pressure was 12.5±4.9mmHg and the contraction pressure was 100.9±25.4mmHg; in subjects without JPD these values were 19.6±5.0mmHg and 136.6±28.3mmHg, respectively. The differences were statostocally(p<0.01) for basal and contraction pressures. Wave frequency was not significantly different in subjects without JPD(7.3±2.3/min) and with JPD(8.5±1.0/min). The mean percentages of antegrade, simultaneous and retrograde sequences in subjects with JPD were 39.3±11.0%, 17.7± 8.3% and 43.0±11.9%. They were 66.4%±11.0%, 20.0±4.9% and 14.2±9.1%, respectively, in subjects without JPD. The difference was statistically significant(p<0.01) for antegrade and retrograde sequences. The insufficiency of SO in subjects with JPD with JPD could play a major role in the formation of hepatocholangiopancreatic diseases by duodenobillary and duodenopancreatic refluxes.View full abstractDownload PDF (9284K) -
Kenichi Yanagawa, Hiroji Nishino, Kazuhiro Takeuchi, Ryugo Sawada, Yos ...1996 Volume 29 Issue 1 Pages 38-43
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSince June 1992, intraportal ultrasonography (IPUS) had been performed in 22 pancreatobiliary cancer patients to evaluate the degeee of portal vein involvement, which was determined by demonstrating changes in the portal vein wall directly. The degree of portal vein involvement was classified into 4 groups as V0-3 according to the General Rules for Cancer of the Pancreas. Comparative analysis between the IPUS findings and operative or histological findings was carried out. The IPUS findings were accurate in 17 of 18 cases and of 8 cases when compared with operative and histological findings, respectively. Mass echoic lesions in the portal vein were detected in two cases, and both of them were diagnosed as tumor emboli. One actually was a tumor embolus, but the other was a portal thrombus. In conclusion, IPUS was useful in diagnosing the degree of portal vein involvement in pancreatobiliary cancer. But it is difficult to evaluate mass echoic lesions in the portal vein by IPUS, and further study will be necessary to obtained an accurate diagnosis of such lesions.View full abstractDownload PDF (11335K) -
Experimental Study on the Effects of Hepatopancreatectomy on Wound Healing of Intestinal AnastomosesKeiichi Okano, Taijirou Tsubouchi, Takashi Maeba, Hajime Maeta1996 Volume 29 Issue 1 Pages 44-52
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo investigate the effects of hepatopancreatectomy on wound healing of experimental intestinal anastomoses, the anastomotic bursting pressure, anastomotic hydroxyproline content, serum protin level and histological changes were evaluated. Rats underwent jejunal anastomoses with either a simple laparotomy (control group), 68% hepatectomy (Hx group), 45% pancreatectomy (Px group) or 68% hepatectomy and 45% pancreatectomy (HPx group). The anastomotic bursting pressure was significantly lower in the HPx group on postoperative days (PODs) 3 and 7 than in the control group (p<0.05). The hydroxyproline content was significantly lower inthe Hx, Px, and HPx groups on POD 7 than in the control group (p<0.05). The serum total protein level was significantly lower in the HPx group on POD 3 than in the control group (p<0.001). Histological examination of the anasomoses in the HPx group showed significantly delayed healing and suppression of neutrophil infiltration on POD 1 compared to the other three groups. These results suggest that the suppression of neutrophil infiltration in the anastomoses in the early period and serum protein depletion impaired the healing processs of intestinal anastomoses after hepatopancreatectomy.View full abstractDownload PDF (18515K) -
Hitoshi Katanagi, Toshiaki Yoshioka, Osamu Aizawa, Yuri Saito, Osamu M ...1996 Volume 29 Issue 1 Pages 53-57
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThis study, which included 330 cases of advanced colorectal cancer, assessed the effects of mixed histologic types within primary cancer on the lymph node metastatic rate. We investigated the histologic type contained in primary cancer with a high lymph node metastatic rate, and the nodal metastatic rates of each histologic type depending on their volume within primary cancer. Cancer which contained a poorly differentiated histologic type as a minor subpopulation within the primary cancer (73%) had a significantly higher nodal metastatic rate than cancer without mixed histologic types (48%) (p<0.05). When primary cancer contained the poorly differentiated or mucinous histologic type as a minor subpopulation, the nodal metastatic lesion usually contained the histologic type of a major subpopulation and seldom contained the poorly differentiated (23%) or mucinous (16%) histologic type. From these results, it was considered that the condition which promotes the development of the poorly differentiated histologic type within a primary cancer is important in lymph node metastasis in cancer with mixed histologic types.View full abstractDownload PDF (9440K) -
Hidejirou Kawahara, Katsuya Hirai, Teruaki Aoki, Ken Ashikaga, Chiko K ...1996 Volume 29 Issue 1 Pages 58-62
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWedetermined the significance of the lateral dissection in lower rectal cancer cases, by comparing the D3 dissection group and the incomplete D2 dissection group. Incomplete D2 dissection is lymph node dissection along the frontal wall of the internal iliac artery, So in the group lymph nodes around the internal iliac artery was dissected only partially. Sixty-five patients with stage II-IIIb lower rectal cancer who had undergone D3 or incomplete D2 dissection between 1980 and 1991, without postoperative distant metastasis, were evaluated. In the stage II cases there was no significant difference in the cumulative survival rates between the D3 and incomplete D2 dissection groups. Therefore, it is enough for curability that the stage II patients undergo incomplete D2 dissection. On the other hand, in the stage IIIa, b patients, the D3 dissection group had a better 5-year survival rate than the incomplete D2 dissection group. The extension of group 2 lymph node metastasis was significantly greater in the D3 dissection group than the incomplete D2 dissection group. Therefore, the reason why the D3 dissection group has a better outcome than the incomplete D2 dissection group with lymph node metastasis is not only that the group 3 lymph nodes are dissected, but also that the extension of the group 2 lymph nodes, especially the lymph nodes at the internal iliac artery area, is dissected completely.View full abstractDownload PDF (9997K) -
With Reference to Serum Cytokine Levels and Organ DysfunctionYoshiaki Murakami, Takashi Yokoyama, Yuji Imamura, Takashi Kodama, Yos ...1996 Volume 29 Issue 1 Pages 63-69
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe relationship between the peripheral polymorphonuclear leukocyte (PMN) count in the early postoperative period and serum cytokine (granulocyte colony-stimulating factor (G-CSF) and interleukin 8 (IL-8)) levels of organ dysfunction were investigated in 10 patients each with esophageal cancer, gastric cancer and peritonitis due to perforation of the gastrointestinal tract. The patients with low PMN counts (<7, 000/mm3) at 4 hours after surgery (group L) developed organ dysfunction significantly (p<0.01) more often than those with high PMN counts (≥7, 000/mm3) at 4 hours after surgery (group H). The serum G-CSF and IL-8 levels of group L were signficantly (p<0.05) higher than those of group H in the early postoperative period. There were significant correlations (p <0.05) between the PMN count at 4 hours after surgery and degree of organ dysfunction or maximum serum cytokine level. These results suggest that organ dysfunction may be caused in patients with a low PMN count in the early postoperative period because PMNs that are excessively stimulated by hypercytokinemia infiltrate into the tissues, and peripheral PMN counts in the early postoperative period may be a predictor of organ dysfunction after surgery.View full abstractDownload PDF (14244K) -
With Special Reference to Cell Proliferation and ApoptosisNaohiko Koide, Yoshinori Nimura, Shoichiro Koike, Wataru Adachi, Futos ...1996 Volume 29 Issue 1 Pages 70-74
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of esophageal adenoid cystic carcinoma (ACC). Histochemical examinations were carried out in order to clarify apoptosis and cell proliferation of adenoid cystic carcinoma. A 68-year-old wouman had an protruding esophageal tumor with irregularly shaped ulceration. The biopsy specimen showed SCC. She underwent subtotal esophagectomy. Histopathological examination showed ACC with SCC. This specimen was subjected to further histochemical examinations: PCNA immunostaining, TUNEL and bcl-2 protein immunostaining. The PCNA-labeling index and TUNEL-positive rate were 43.6% and 0.58%, respectively, in ACC tissue. These results indicated that this unique tumor exhibited high proliferative activity and weak apoptosis. In normal esophageal tissue, the basal cells and ductal and acinar cells of esophagel gland showed a positive reaction for bcl-2 protein. It was considered that the tumor originated from the basal cells of esophagus based on the strong expression of bcl-2 protein and histopathologically complication of SCC tissue.View full abstractDownload PDF (10337K) -
Reijiro Saito, Shichisaburo Abo, Michihiko Kitamura, Masaji Hashimoto, ...1996 Volume 29 Issue 1 Pages 75-79
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe conducted a clinicopathological study on the incidence of esophageal carcinoma with intramural metastasis to the stomach and its relationship to prognosis and survival. The data on 384 patients with esophageal carcinoma who underwent esophagectomy in our department from January 1981 through August 1994 were reviewed. In (1.6%) patients, intramural metastasis to the stomach was observed, and the histologic type was squamous cell carcinoma in all cases. Lymphatic invasion and lymph node metastasis were observed in all cases and the histological stage was III in one case and IV in 5 cases. The mean size of the metastatic lesions was 3.1 cm, though giant protruding tumors (7 and 6 cm in diameter) were observed in 2 cases. The outcome was very poor, with all except one of the patients dying. The mean survival time was 8.3 months (range 2-17). The two patients with giant metastatic tumors died within 5 months. Not only lymph node metastasis but also distant organ metastasis (liver in 3 cases, bone in 1 case) were observed as the site of recurrence. These data indicate that an extended operation and postoperative chemotherapy are necessary to improve the outcome for patients with intramural metastasis to the stomach. However, if the metasatic tumor is larger than 6 cm in diameter, preoperative chemotherapy must be combined with surgery because of the systemic spread of the carcinoma.View full abstractDownload PDF (9471K) -
Takumi Shimomatsuya, Nobuhiko Tanigawa, Makoto Yoshida, Hirokazu Amaya ...1996 Volume 29 Issue 1 Pages 80-84
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe gastrointestinal tract is a common site for metastases in malignant melanoma. However, there is no prior report of surgically resected metastatic malignant melanoma of the duodenum. We report a patient, who was treated by pancreatoduodenectomy for metastatic melanoma. The patient was a 69-year-old woman, who had histories of nasal malignant melanoma and cecal cancer. She was hospitalized because of dizziness and tarry stoll. Endoscopic examination revealed a blackish elevated lesion in the second portion of the duodenum, and biopsy confirmed the diagnosis of metastatic malignant melanoma. As no other metastases were found by systemic examinations, pancreatoduodenectomy was performed. Adjuvant chemotherapy was carried out 2 months after the operation and she was discharged 3 months after surgery. In April 1995, 6 months after surgery, there were no signs of recurrence.View full abstractDownload PDF (9089K) -
A Case of Postoperative Bile Duct Stone by Aberrant Surgical Clip after Laparoscopic CholecystectomyHideo Takahashi, Kenji Yokoi, Masanari Wada, Tarou Yamato, Naoki Miyam ...1996 Volume 29 Issue 1 Pages 85-88
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe patient was a 79-year-old man who consulted our department with jaundice as the chief complaint. He had received laparoscopic cholecystectomy for cholelithiasis 7 months previously. Biochemical examination of his blood sample showed disturbance of hepatic function and an increase in biliary enzymes. Abdominal ultrasonography revealed an enlarged intrahepatic bile duct and common bile duct, and abdominal CT demonstrated metallic density in the lower part of the common bile duct. PTCD showed 2 calculus-like shadowy defects in the common bile duct, in each of which there were total of 3 clips previously been used. As treatment (total twice), we performed endoscopic papillotomy and lithectomy using smashing basket forceps and removed the common bile duct stones, which were relatively soft bilirubin stones. One clip was taken back. This case is a very rare complication according to the literature. However, in accordance with the prevalence of laparoscopic cholecystectomy, such cases will increase and should thus be kept in mind.View full abstractDownload PDF (7366K) -
Masahiro Kamiga, Kiyoshi Sato, Yasuhiko Midorikawa, Minoru Hanada, Yuk ...1996 Volume 29 Issue 1 Pages 89-93
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of severe, acute pancreatitis without any associated pain during the clinical course is reported. The patient, a 45-year-old man, was admitted to our hospital with chief complaints of nausea, vomiting and jaundice. Based on the results of hematological and blood chemical analyses and abdominal CT, a diagnosis of severe, acute pancreatitis was made. However, he reported no abdominal pain at all at the onset or after hospital admission. Immediately after admission, the patient was placed under strict systematic care while being treated with proteolytic enzyme inhibitors and continuous hemodialysis. In spite of this intensive conservative therapy, the platelet decreased suddenly, the patient gradually showed a tendency toward DIC and suspected the infection of pancreatic tissue, he was underwent surgery on the 10th day. The pancreas was almost entirely necrotic, and the pathologic process spread extensively to the retroperitoneal space. The necrotic tissue was excised as much as possible. During the postoperative period, the patient developed MRSA pneumonia and a peritoneal abscess, which made recovery difficult. After a slow and gradual recovery, he was discharged on the 105th postoperative day. This patient lacked the abdominal pain that develops in almost all cases of acute pancreatitis, thus delaying early diagnosis and treatment. Such delays may result in a poor outcome, so clinicians should be alerted to these atypical cases.View full abstractDownload PDF (9371K) -
Masakazu Ohno, Naoyuki Miyazaki, Naoya Katayama, Eisen Arahi, Yasuhide ...1996 Volume 29 Issue 1 Pages 94-98
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSplenic abscess is relatively rared. We experienced an extremely rare case of splenic abscess caused by colonic penetration associated with transverse colon cancer. The patient was a 67-year-old woman with a chief complaint of periunbilical pain and vomiting. She was admitted under the diagnosis of ileus for niveau on abdominal X-P and severe leukoplasia. Abdominal ultrasonography and computed tomography showed multilocular splenic abscess. Colonoscopy and contrast enema revealed 2' type transverse colon cancer in the splenic flexura. The preoperative diagnosis was ileus and splenic abscess due to colonic penetration associated with transverse colon cancer. Partial colectomy, splenectomy and peritoneal drainage were performed after 14 days from colonostomy. The lesion, located in the transverse colon, penetrated the spleen and induced multilocular abscess. The pathological examination revealed that the splenic abscess developed from a direct extension of the colon cancer. Cultures of the abscess grew Escherichia coli. Surgical resection is the first choice of therapy for splenic abscess developing from direct penetration of colon cancer.View full abstractDownload PDF (9835K) -
Mitsuhiro Matsuda, Shinya Adachi, Isamu Morishima, Takahiko Kawashima, ...1996 Volume 29 Issue 1 Pages 99-103
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of pseudomyxoma peritonei appearing as inguinal hernia is presented with a review of previous reports. A 55-year-old man underwent repair of a right inguinal hernia after conservative reduction by incarceration. The removed hernia sac contained mucinous tumors. Histological diagnosis was pseudomyxoma peritonei. Radiological examinations revealed that the appendix was replaced by a cystic mass. An ileocecal resection was performed. Microscopic findings were those of a mucinous cystadenoma. This is the fifth case of pseudomyxoma peritonei appearing as inguinal hernia.View full abstractDownload PDF (8531K) -
Koutarou Maeda, Taijirou Mori, Mitsumasa Hashimoto, Gengo Tajima, Hide ...1996 Volume 29 Issue 1 Pages 104-108
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 9-year-old boy was admitted to our hospital due to vomiting for 4 days. He had no history of operation. A plain X-ray film demonstrated dilated intestinal gas. Ultrasonography showed a cystic mass 10 cm in diameter cranial to the cystic bladder. Drainage of the cystic mass using ultrasonography was performed because the cystic mass was considered to be the origin of obstructive ileus. Chylous fluid (200 ml) was drainaged, and ileus disappeared the following day. Mesenteric chylous cyst was suspected by CT scanning as well. Elective surgery for mesenteric chylous cyst was performed due to persistent drainage of fluid, although ielus did not occur again after the drainage procedure. Laparotomy showed a dark red mesenteric cyst of the jejunum 8 cm in diameter. Partial resection of the jejunum was performed. The size of the cyst was 7.5 × 6 cm in diameter, and histological study showed lymphangioma of the mesentery. This case is considered to show the usefulness of ultrasonography and ultrasonographic drainage for primary ileus in childhood.View full abstractDownload PDF (10392K) -
Masahiko Tsurumaru1996 Volume 29 Issue 1 Pages 109-113
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPostoperative complications and perioperative care in radical esophagectomy with three field lymph node dissection were described. The four main complications are pulmonary complications, circulatory complications, anastomotic leakage and recurrent nerve palsy. Hypoxemia was seen at a rate of 22.5%, which was caused mainly by pneumonia, atelectasis and pulmonary edema. Pulmonary edema or potential pulmonayr edema developed frequenctly after radical esophagectomy with removal of the thoracic duct. which is thought to be important for elimination of cancer cells. Combined resection of the esophagus and the thoracic duct causes hypoproteinemia or intravascular dehydration, which requires infusion of 7-8 ml of solution/kg/h during the operation. Consequently, hypoxemia sometimes occurs in the refilling period. Howerver, it is successfully controlled by administration of DOA, albumin and a diuretic(furosemide). It should not be ingnored that dry sided maintenance of fluid, which is said to be better to obtain a sufficient level of arterial oxygen, results in serious tachycardia with hypotension. Pulmonary embolsim is a less common but serious complication, occurring at a rate of 3.3%. It is advisable to use a pneumatic cuff on both legs through the perioperative period to prevent pulmonary embolism. Administration of heparin is also effective for avoiding pulmonary embolism. Recurrent nerve palsy is one of the causative factors of pulmonary complications. We should be aware that some postiperative complications are clearly attributable to lack of skill in the techniques of operative procedures.View full abstractDownload PDF (9077K) -
Kiyoshi Sawai1996 Volume 29 Issue 1 Pages 114-119
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe secret of safe total gastrectomy with acceptable postoperative complications includes an appropriate approach and use of a retractor to provide a good operative field, keeping to the fundamentals in reconstruction, and effective drainage. The first choice for esophagogastrostomy is auto suture. Howerver, when problems occurred during auto suturing, repair should be done by hand suturing. Re-laparotomy is effective against primary postoperative bleeding and arterial embolization is effective against secondary postoperative bleeding. Anastomotic leakage can be cured by effective drainage, after its exact determination of its location, quantity and effectiveness of drainage by fluoroscopy. Massive bleeding due to pancreatic fistula can be controlled by arterial embolization. Conservative therapy using a long balloon catheter for intestinal obstruction due to adhesions should be continued for 7 to 10 days. When conservative treatment is ineffective against postoperative cholecystitis, percutaneous trnashepatic gall bladder drainage should be used. An abscess in the peritoneal cavity can be diagnosed by echography or computed tomography and drainage should be done under the guidance of echography or computed tomography.View full abstractDownload PDF (12894K) -
Yoshiro Matsumoto1996 Volume 29 Issue 1 Pages 120-126
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSComplications following hepatic resection and their care were studied. Indications for the procedure are primary liver cancer, benign liver tumor, bile duct cancer of the hepatic hilum, gallbladder cancer and primary intrahepatic stone. There is a high incidence of the complications in patients with chronic liver disease (LC) who underwent hepatic resection, and in those who did hepatic resection of more than one segment, accompanied by pancreatoduodenectomy. The complications in the patients with LC are mainly fluid collection, bule leakage, and abscess formation at the resection edge of the liver, and following hepatic failure. Primarily, effective drainage from the edge is the most important procedure for care of the complications. With regard to postoperative complications of hepato-pancreatoduodenectomy, hepatic failure, leakage of the pancreatojejunal anastomosis and intraabdominal infection are the chief complications. The mortality of the patients undergoing hepatic resection of more than 2 segments is reported to be from 33% to 47%. Although the pathogenesis of the complications in these patients is not clear, we suspect that the catabolic phase after their surgery is prolonged and in the prolonged phase, massive bleeding, infection and hemodynamic changes can easily cause the complications.View full abstractDownload PDF (13364K) -
Toshihide Imaizumi1996 Volume 29 Issue 1 Pages 127-131
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSince 1968, 964 patients have received pancreaticoduodenectomy(PD) in our department. Early complications occurred in 27% of the patients and the hospital death rate was 9%. One-third of the early complications resulted from insufficiencies of the pancreaticojejunostomy, which were found in as high as 11% of the patients with a soft normal pancreas without fibrosis(p<0.001). These insufficiencies consisted of surgical pancreatic injury, stenosis of the pancreatic duct and a resultant intraperitoneal abscess and bleeding. Thorough draiange around the site of the pancreaticojejunostomy with careful monitoring of the surgical pancreatic injury is important in the management of the former two conditions, and the US/CT drainage or TAE is useful for the latter two conditions. As late complications, cholangitis(in 13% of the 964 patients), which results from stasis in the reconstructed jejunum due to the abolition of the duodenal papillary sphincter function after PD, and pancreatitis(3%) occurred in addition to the stenosis at the site of the choledocho/pancreaticojejunostomy. Diabetes mellitus(7%) and peptid ulcer(3%) were also observed. These complications were effectively managed by bougienage and/or reanastomosis and by jejunal adhesiotomy and/or alteration of the method of reconstructing the choledocho-/pancreaticojejunostomy after PD. The US/CT-drainage was effective in the management of liver abscess.View full abstractDownload PDF (10897K) -
Yutaka Yamamoto, Hiroyuki Yoshida, Souichirou Issiki, Atsushi Shimada, ...1996 Volume 29 Issue 1 Pages 132
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (2114K) -
Kazuma Aoki, Yuima Okamura, Kiyoshi Ishida, Masahiko Yamazaki, Tokio Y ...1996 Volume 29 Issue 1 Pages 133
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (2102K)
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